Provider Demographics
NPI:1841581162
Name:MAZOLEWSKI OC MEDICAL PC
Entity Type:Organization
Organization Name:MAZOLEWSKI OC MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZOLEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-481-8282
Mailing Address - Street 1:31461 RANCHO VIEJO RD
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1864
Mailing Address - Country:US
Mailing Address - Phone:949-481-8282
Mailing Address - Fax:949-218-6303
Practice Address - Street 1:31461 RANCHO VIEJO RD
Practice Address - Street 2:STE 103
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1864
Practice Address - Country:US
Practice Address - Phone:949-481-8282
Practice Address - Fax:949-218-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84094208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty